| NPI | 1770859944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL ME140000) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX R3785) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME140000) | |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2019-11-15 |